Valvular Disorders And Murmurs Flashcards
What are the two most common type of heart valve disorders?
Mitral and aortic valve disorders
What is the definitive procedure or diagnostic test to diagnose heart valve disorders?
Two-dimensional echocardiography
What test can you expect a primary care processor to order and then referring to the cardiologists? List three
Echocardiogram, EKG, and chest x-ray
Aortic stenosis is confirmed by which diagnostic test?
It is confirmed by echocardiography
What does an echocardiography show in a patient who has aortic stenosis?
Increase maximum aortic velocity, increase mean pressure gradient across the valve, and a decreased aortic valve area
What is the definitive treatment for aortic stenosis?
Surgical or transcatheter aortic valve replacement
What diagnostic test is contraindicated in patients with symptomatic aortic stenosis? And why?
Exercise stress testing is contraindicated and symptomatic Eriksen houses going to risk of complications, including hypotension
Name this condition: this is obstruction of a left ventricle systolic outflow across the Aortic valve at the aortic valve level, do the narrowing of the valve orifice 
Aortic stenosis 
How many years can it take for a patient who has aortic stenosis to begin becoming mild least symptomatic?
10 to 15 years
What is the most common presenting symptom of Aortic stenosis?
Exertional dyspnea
What are some other symptoms a patient can experience with aortic stenosis?
Fatigibility, progressive inability exercise, dyspnea, chest pain, syncope.
Advanced symptoms are orthopnea, paroxysmal nocturnal dyspnea, peripheral edema
On auscultation what can be heard in a patient that has aortic stenosis? 
Crescendo – decrescendo or systolic ejection murmur. Loudest in the Aortic area and radiating toward the carotid arteries (thrill) 
What extra heart sound may be heard in a patient that has aortic stenosis?
S4 heart sound (gallop)
Can be heard due to forceful atrial contraction in response to a hypertrophied left ventricle
What abdominal finding is common with a patient who has severe aortic stenosis?
Hepatomegaly may be noted in patients with severe aortic stenosis and right sided heart failure
Rheumatic heart disease can damage the valve at any age and it’s typically caused by what type of infection in childhood?
Group a streptococcal infection
What 2 tests should be done at baseline for aortic stenosis?
ECG and chest x-ray should be performed at baseline in all patients
What is aortic sclerosis? 
It is thickening or calcification of the aortic valve in the absence of valve obstruction
Precursor to aortic stenosis 
With ventricular septal defect being a differential diagnosis for aortic stenosis, what type of murmur is common with the VSD? 
holysystolic murmur, it’s present if the left ventricular pressure is higher than the right
Echocardiography will differentiate, defect reveals defect in septum and in left to right flow
What is the recommended strategy for most asymptomatic patients with aortic stenosis?
Watchful waiting
What is the definitive treatment for aortic stenosis?
Valve replacement
Patients that have aortic stenosis that are unsuitable candidates for surgery should have what procedure done?
Transcatheter Aortic valve replacement
What medication is used for thromboembolism prophylaxis and patients with aortic stenosis?
Warfarin
Antibiotic Prophylaxis against infective endocarditis is recommended for what type of procedures?
It is recommended before dental procedures that involve manipulation of gingival tissue, manipulation of periapical region of teeth, or perforation of the oral mucosa.
What antibiotic is prescribed for endocarditis prophylaxis?
Amoxicillin trihydrate oral tablet, 2 g as a single dose given 30 to 60 minutes before procedure
What is the recommendation for symptomatic aortic stenosis? In regards to physical activity
Avoid strenuous activity
Where are the two types of valves that can be used in a aortic valve replacement? 
Mechanical valve or bioprosthetic valve
What is Important to know for mechanical valve?
They are durable, less likely need to be replaced. Requires ongoing anticoagulation. Is good for patience younger than 50 years who don’t have a contraindication to anticoagulation.
What is important to know about bioprosthetic valve?
They are less durable, they last 10 to 15 years, avoids the need for ongoing anticoagulation. It’s recommended for patients that are contraindicated for anticoagulant therapy.
What is percutaneous aortic balloon valvuloplasty? 
A balloon is inserted in the femoral artery in his inflated there by opening the valve
This is a bridge to surgical aortic valve replacement and a TAVR
What are some complications associated with aortic stenosis?
Left ventricular hyper trophy, heart failure, pulmonary hypertension, atrial fibrillation, acute coronary syndrome, homeowner edema, and infective endocarditis
Which stage is this for aortic stenosis classification:
Patient is asymptomatic with risk factors for development of valvular heart disease. 
Stage A, (at risk)
Which stage is this for aortic stenosis classification:
Patient is asymptomatic but meets criteria for mild to moderate valvular heart disease
Stage B, (progressive) 
Which stage is this for aortic stenosis classification:
Patient is asymptomatic for meets criteria for severe valvular heart disease
Stage C (asymptomatic/severe)
Which stage is this for aortic stenosis classification:
Patient is symptomatic and meet criteria for severe valvular heart disease
Stage D, (symptomatic/severe)
What race is predominant prevalent in Aortic stenosis?
White population
What is mitral regurgitation?
It is the backflow of blood from the left ventricle to the left atrium during ventricular contraction, it is caused by a structural or functional mitral valve abnormality.
And it may lead to increased left arterial pressure, left ventricular dilation and dysfunction and left ventricular failure.
Acute mitral regurgitation may be caused by what? List 4
It can be causedby papillary muscle rupture after acute MI or rupture of chordate tendinae
Perforation of valve leaflets in infectious endocarditis
Cardiac trauma
Chronic primary mitral regurgitation is caused by degenerative or structural abnormalities of the mitral valve most commonly what?
What are other causes?
Mitral valve prolapse
Other causes: infectious endocarditis, rheumatic mitral valve disease, radiation heart disease, connective tissue diseases
Describe chronic secondary mitral regurgitation
The mitral valve is structurally normal and regurgitation is caused by left ventricular dysfunction associated with ischemia or other myocardial disease
Mitral regurgitation is diagnosed based off of what two things?
Cardiac auscultation and echocardiography
Describe the classic murmur associated with mitral regurgitation
The classic murmur associated with mitral regurgitation is a blowing, high pitch holosystolic murmur that is loudest at Apex, radiating to axilla
What is the most preferred procedure in patients with mitral regurgitation?
Mitral valve repair
It is not mitral valve replacement!
What are the three effects from mitral regurgitation on the left side of the heart? 
It can cause increased left atrial pressure, left ventricular dilation dysfunction, and left ventricular failure
Primary mitral regurgitation (degenerative) Is caused by what?
Is caused by structural abnormality of mitral valve components.
Commonly caused by mitral valve prolapse, infectious endocarditis, radiation heart disease, connective tissue diseases, Rheumatic mitral valve disease
Which stage for mitral regurgitation is this:
Progressive mitral regurgitation, asymptomatic, mild enlargement of left atrium, no enlargement I left ventricle, pulmonary pressures within reference range.
Stage B
Progressive mitral regurgitation
Which stage for mitral valve prolapse is this:
At risk of developing mitral regurgitation, asymptomatic, mild abnormalities of mitral valve structure.
Stage A
At risk of developing mitral regurgitation
Which stage for mitral valve prolapse is this:
asymptomatic, Severe mitral valve prolapse with loss of coaptation or flail leaflet, Left atrial and left ventricular enlargement, Pulmonary hypertension may be present.
Stage C
Asymptomatic severe mitral regurgitation
Which stage for mitral valve prolapse is this:
Symptomatic, severe mitral valve prolapse with loss of coaptation or flail leaflet, left atrium and left ventricular enlargement, pulmonary hypertension present
Stage D
Symptomatic severe mitral regurgitation
For secondary (functional) mitral regurgitation is caused by what? What happens to cause the regurgitation?
Caused by left ventricular dysfunction that is associated with ischemia
The mitral valve chords and leaflets are normal structurally but loss of co-optation occurs owing to left ventricular dilation and papillary muscle displacement
The sudden onset of symptomatic mitral regurgitation after rupture of papillary muscle or chordae tendineae or perforation of valve leaflets
What is this?
Acute mitral regurgitation
Rare medical emergency requiring urgent intervention
Severe mitral regurgitation may result in what symptoms? Think CHF
Dyspnea or shortness of breath at rest or on exertion
Orthopnea (sob lying flat)
Paroxysmal nocturnal dyspnea ( wake up short of breath at night)
Reduced exercise tolerance, palpitations, fatigue, ankle swelling.

What is the most common finding in long-standing chronic and acute mitral regurgitation ?
Atrial fibrillation
Finding suggestive volume overload that may be present include what? List eight
Tachypnea, Tachycardia, cool extremities, crackles, rales or wheezes, peripheral edema, jugular vein distention.
On palpation of chest of a pt with mitral regurgitation, the apical impulse (pmi) is located where?
It can be laterally displaced due to left ventricular enlargement 
What type of thrill may be detected in acute or severe mitral regurgitation?
A precordial thrill
A holosystolic murmur that is atypical, absent, or quiet in what? 
Acute severe mitral regurgitation
Presence of S3 heart sound suggest what?
Acute or severe mitral regurgitation
What are the risk factors for mitral regurgitation?
Advancing Age
Prevalence of males and females similar.
Mitral valve prolapse, rheumatic heart disease, infectious endocarditis, myocardial infarction, ischemic heart failure, hypertrophic cardiomyopathy, left ventricular systolic dysfunction, hypertension, history of radiation therapy, renal dysfunction, mitral stenosis, lower BMI
What is the difference in location for a systolic murmur that occurs in mitral regurgitation and aortic stenosis?
In mitral regurgitation, the murmur is heard best over the apex of the heart (left, 5th intercostal space) And radiates to the axilla
In aortic stenosis, the murmur is heard best over the 2nd right intercostal space and radiates to the carotid arteries
Athletes with primary mitral regurgitation should undergo clinical evaluation with which two tests?
Athletes undergo yearly clinical evaluation, with Doppler echocardiography and exercise stress testing
How often should you clinically evaluate asymptomatic patients with mitral regurgitation?
At least annually
After in mitral valve repair you should obtain a repeat echocardiography when?
Before discharge or within three months postoperatively
what patients should be screened for aortic stenosis?
Screen first Degree relatives of individuals with known bicuspid aortic valves for aortic valve disease
Echocardiography is used for screening
What are some complications associated with aortic stenosis?
Left ventricular hypertrophy, heart failure, pulmonary hypertension, atrial fibrillation, acute coronary syndrome, pulmonary edema, infective endocarditis
What is bicuspid Arctic valve?
Is a common congeneral disorder of the heart, is a result a partial or complete fusion of two of the aortic valve leaflets
 What is the most common cause for valvular aortic stenosis in person’s younger than 65 years of age?
Bucuspid aortic valve 
